Podcast Introduction

Brian: Hi, this is Brian and you’re listening to the very first episode of The Extraordinary Friends Show, a combination public access TV show and podcast, where I sit down with a couple of my good friends and talk about their careers, hobbies, and life experiences. In this episode, my co-host is my longtime friend, Chris Alme, and together we talk with fellow poker buddy, and friend Dr. Stephen Meade, known, of course, to us as Steve, about what it’s like to be a family physician. Steve tells us about who are the worst kind of patients, what he hates most about his job, and the grossest thing he’s seen as a doctor.

Brian: Plus, of course, all the good things about being a doctor. Steve also lets us in on a dirty little secret, that being what the admitting nurse writes down when you don’t give a reason for why you wanna see your doctor. Both Steve and Chris are really witty guys, with easy laughs and together we had a really fun conversation. And if you stick around to the very end I’ve added some post show outtakes. Pretty funny stuff, so enjoy.

Show

Brian: Hello, and welcome to The Extraordinary Friends Show. Tonight I’ve got two of my good friends here with me, and on my left we have Chris Alme, he is my co-host tonight. Chris?

Chris Alme: Thank you.

Brian: [chuckle] On my right we’ve got Dr. Steve Meade. He’s our guest tonight. We’re gonna be talking all about what it’s like to be a doctor. I had a whole speech written up about how the show was gonna work and everything else, and then I just canned it all ’cause I’d rather just get into it, alright. But I will spend a couple of minutes just saying… So, Chris, first of all, you and I, we’ve known each other for about 10 years, we worked together at a client’s. You’ve been to a doctor, I take it?

CA: I have.

[chuckle]

Brian: Yeah, that’s good. So you have some questions for Steve?

CA: Yeah.

Brian: Alright. And Steve, I’ve known you for about three years, right?

Dr. Stephen Meade: Yep.

Brian: [chuckle] And, so we’re going to jump in, and try to make it more than like half-syllable answers, if possible.

[laughter]

Brian: If possible.

DM: I’ll see what I can do.

Brian: Okay, good. Alright. So, the show that we’re doing is just a conversation, as you can tell already, and so unlike other shows, my co-host is gonna be a big part of it and we’re just gonna try to find out what it’s like to be a doctor. Because we’ve been to the doctor, but we don’t know what it’s like to be a doctor. And so we’re just gonna dig in, maybe with the opening question. So, how did you decide to be a doctor?

DM: Probably decided when I was in high school. I liked science, I liked math, wasn’t very good at English. And so I figured I should probably do something where I don’t have to write a lot. And then…

CA: Is that why we can’t read the prescriptions?

DM: Yeah, exactly. [chuckle] And I figured I’d probably end up either being an algebra teacher or become a doctor. And I just started going down that path.

Brian: Just wanna clarify, algebra teacher or doctor?

DM: Yeah, that’s how the chips were gonna fall.

Brian: Where did it veer off, when did you make…

DM: Oh, it was always gonna be doctor, but if I wasn’t able to make it through…

Brian: That was your fallback?

DM: That was my fallback.

Brian: Got it. So here’s the thing, I’m gonna jump right into it, because here’s the thing that I think is interesting about doctors: Doctors have to know everything, like presidents… Candidates are expected to know everything. Doctors are similar, right? Do you feel like you have to know everything, or do you just fake it a lot?

DM: Fake it a lot, and it depends upon the type of doctor. Some of the general practitioners, or primary care doctors, we don’t have to know everything because we can send to a specialist.

Brian: [chuckle] Right.

DM: A specialist, they kinda do need to know everything, but it’s about a small area, and so if you go to the specialist and you wanna bring up something else they’ll say, “Go see a regular doctor for that.”

Brian: So, do you ever Google stuff? Just scurry out of the room and go Google…

DM: Well, I have a general idea but a lot of times… I use the Mayo Clinic site a lot. I…

Brian: While the patient is there?

DM: Yeah, in the room, and I’ll print out information sheet for them and I always say that there’s this fly-by-night place down in Rochester, [chuckle] but they put some great information on the internet.

Brian: So do they get a discount then, when you don’t know?

DM: No, they don’t.

[laughter]

DM: Although a couple have called in and asked, “You didn’t figure out my problem, can I get a refund?” To which I say, “No”.

Brian: Is that serious?

DM: Yeah. Well, we call it the practice of medicine ’cause we hope to get it right someday.

Brian: There you go. {rim shot}

DM: Exactly.

Brian: Nice.

[chuckle]

Brian: So, patients. What are the best kinda patients? What are the worst kinda patients?

DM: They’re any age. The patients who come in and they wanna go over one or two particular things, they’re normally better just ’cause it’s a little bit more straightforward. The people who come in with a list of seven things when it says that they’re coming in for one thing [chuckle] is a little bit more difficult. Those that quote Dr. Oz, also interesting patients because sometimes it’s…

Brian: Do they argue with you?

DM: Oh yeah. I think the internet has allowed patients to be more well-informed, which is good.

Brian: Or misinformed.

DM: Yeah, or misinformed.

CA: Self-diagnosed quite a bit.

DM: Yeah, yeah.

Brian: What are some of the worst self-diagnoses you’ve heard?

DM: A lot of it seems to pertain to yeast. Some people think they have an all-over body yeast infection, which they may, but…

Brian: That’s a thing?

CA: Wait, wait, all?

[laughter]

DM: I mean just, it’s in their bloodstream and it’s causing their fatigue, and it’s constant…

Brian: Oh, it’s in…

DM: Yeah. And…

Brian: ‘Cause I think we only know of it from one instance…

CA: Yeah, yeah, yeah. There was…

DM:Thrush. I’m sure you’re talking about thrush, when the babies get it in their mouth, the yeast infection in their mouth.

Brian: Yes. That could’ve been it. That could’ve been it.

CA: That one too. That’s two that I know of.

DM: Yeah.

[laughter]

Brian: Now I know two, alright. So it’s in their body, right? It’s not outside, it’s not falling off…

DM: Yeah.

CA: Interesting. So where… I was thinking about, I heard something the other day. It was how my disease became your fad diet with Celiac’s disease, so with the gluten-free.

Brian: What does that mean? I don’t know. So I should probably just start off by saying I don’t know anything about anything, so you all got to explain stuff.

[laughter]

CA: Well, yeah. Well, no, there’s everything that like, “Is this gluten-free?” and there’s a big… And so I had heard a podcast about that, and she was talking about somebody that actually had Celiac’s and I had heard that. It’s actually a really lower amount of the population that actually has it versus… So I would imagine there’s a lot of people that…

DM: Some people have more of an intolerance to wheat and gluten-type products. It’s just like the same thing with dairy, lactose, some people digest it pretty well, and they may have some problems, and others, just, it goes right through ’em.

Brian: So do you become more lactose intolerant as you get older, or you realize there’s just an association between the results of lactose intolerance?

[laughter]

Brian: And the fact that you’ve had lactose or whatever, that’s like…

DM: Yeah. The enzyme that you need to produce to break it down, if you… A lot of times people just avoid it ’cause they feel awful if they have anything dairy, so then they’re probably lactose intolerant. But all they know is if they eat that, they’re… And so they avoid it. Yeah.

Brian: I gotcha. So I have a job. This is not my normal job, this is my first time and this is why it’s probably somewhat of a trainwreck, a first episode. This is a first episode.

DM: They used that to describe the Twins’ relievers when they come in and pitch and all…

Brian: Hell breaks loose.

DM: All hell breaks loose.

Brian: Okay, alright. Now I know it, see? I’m learning. I’m learning. I’m learning as we go. But here’s what I was gonna ask you, is that in my job, there are days when I just don’t feel like working, like mid-morning I’ll go, “I’m not doing anything for the rest of today.” And I get paid by the hour. So I stop billing, just to clarify that, if any people listen. But so for your situation, what do you do when you just don’t feel like working, you got a whole litany or whatever, a list of patients coming in?

DM: Yeah. Normally, on a regular day, I probably have anywhere from 20 to 25 patients.

Brian: What does that average? 20 minutes per patient or something like that?

DM: About 15 minutes, a half hour for a physical exam, and then 15 for everything else. And if it’s someone who’s coming in with multiple problems, they get a half hour then too. But for the most part it’s you’re just sitting and talking to people. Kinda like this show.

[laughter]

Brian: That’s right.

DM: So it’s normally not too bad. I work Monday, Tuesday, Thursday, Friday, so they can only hurt me for two days and then I get a day off and then…

Brian: So what do you do on Wednesdays again?

CA: Golf.

DM: It’s my administrative day.

Brian: Administrative day? Okay.

DM: A lot of times that does involve golf.

[chuckle]

Brian: Is that drumming up new clients, or…

DM: No, no. It’s just a…

CA: It’s a “me” day.

Brian: [chuckle] Right. Administrative…

DM: Yes. It’s a mental health day.

Brian: Administrative day.

DM: Yeah.

CA: But I say that half-jokingly because my wife recently went back to work and she’s a pharmacist, and she has the same thing. So, this morning, like you, Brian, my job is pretty flexible, so [chuckle] I may or may not have slept in a little bit. And she’s there on her laptop and she has a home visit at said time and you have to go, you have to perform. So she does a lotta… But I think about that where it’s, just how different it is, what we do, compared to where… We deal with people, but we can blow people off.

Brian: Right. We could just have a meeting to go to, or whatever…

CA: It’s like you have to have empathy and you have to listen. It’s like…

Brian: Yes.

DM: Well, and probably about three, four times a year, I get migraine headaches and if I wake up with a migraine headache it’s gonna be very difficult to sit in a fluorescently-lit room and talk to patients, and so then I’ll call in and I normally feel guilty because they have to call 20 patients, and it’s like, doctors shouldn’t get sick. But…

Brian: But you do, obviously.

DM: Well, I know, yeah. So it happens, but…

Brian: So it’s nothing you can do about that.

CA: So do you bathe in Purell during the day then?

DM: Yes, they’ve got these canisters and you just kinda foam up in another room, and yeah.

CA: Foam in, foam out.

Brian: Alright. So there’s gotta be stuff where you see it on your list, ’cause you must get like patient X or Jane Doe, [chuckle] who wants to talk to you about X, Y, and Z, and you see Z and you go, “God dang it, I do not wanna deal with that.” How often does that happen, where you just go…

DM: It’s not necessarily what’s listed as what they’re coming in for, but there are patients that sometimes you hit it off with a little bit better than others, and there’re some patients that come in every other week, and…

DM: You try to send them to a specialist, but a lot of times the specialist sends them back and says, “Oh, I can’t help you, go back to your regular doctor.”

[laughter]

Brian: Just rejects them and say… It’s like…

CA: Convinced.

[chuckle]

Brian: So what is the one thing, if you can say it… Not the patient obviously, but what is the one thing that you see on the list that you just cannot, you’re just like, “Ruin my day”? Is there anything like that?

DM: Nothing really like that. Well, really, about the only thing is when people come in with forms to fill out.

Brian: What? What do you mean?

DM: I hate filling out forms. And so people will come in with their family medical leave and then I’ve got to fill out like five pages of forms.

Brian: Alright, so I’m just thinking through some of the procedures that I’ve had done on me. And you would rather do one of those than fill out forms?

[chuckle]

DM: Well, maybe not to you, but…

[laughter]

Brian: I wanna go on record, he’s not my doctor. [chuckle] Which is an interesting story too, but…

DM: Yeah, the… A lot of times the procedure, if someone’s coming in to have their toenail taken off for an ingrown toenail, I actually like those because I’m doing something, I don’t really have to talk to the patient that much, and it’s kind of a break in the day.

Brian: How do you take a toenail off?

CA: Very carefully. Years of… You numb up the…

Brian: The whole toe or…

DM: In the toe, at the base of it, the nerve goes up and around and you numb up and you numb up and then it’s all…

Brian: And you can pretty much do whatever you want?

CA: And then…

DM: Yeah, and then you just cut it down, pull it out and… Yeah, I know. And then you put basically some substance in the base of the nail so it doesn’t grow back. You ablate it.

Brian: You intentionally don’t want it to grow back.

DM: For some people, if they get recurrent ingrown toenails.

Brian: And that’s it, no toenails for them from then on.

CA: Interesting.

DM: So then they have a smaller toenail and the nail folds and they just have a smaller toenail.

Brian: Really?

DM: Yeah. Now we’ve gotten really excited.

[laughter]

Brian: So here’s… Okay, when I was first starting out as a… I worked at a company and I had to iron my shirts everyday. And my breakfast at that time was a bagel. So I was cutting my bagel incorrectly, now that I know, and I sliced my finger really bad. And I opened it up and I could see that it was like the tendon maybe, if I’d sliced, right?

DM: Yeah. Yeah.

Brian: I don’t think I saw a bone, but I saw white stuff which I thought, “Well, that’s not good.” And I immediately started to pass out. So, I kind of did get my head between my legs and waited. And then I was ironing a shirt and I kept thinking about, I didn’t even see my finger and I’m thinking about my finger and I’m getting faint…

DM: So you had to finish the ironing before anything was going to…

Brian: Right. I had to go to work, so I had to iron my shirt. And I kept getting faint just thinking about it. So pretty soon I’m on the floor ironing above my head. But the net of this is I can’t deal with blood and so I don’t understand, is there anything that just you are going, “Holy crap, That is way more than I can handle”? Is it…

DM: No, not really. For me I think some of the things that we’ll take off on the back are a big huge oil gland that gets plugged and it’s a sebaceous cyst and sometimes that’s a little more pungent. So, smells…

[laughter]

CA: Wait, it’s coming out of where? Oh yeah. The back. Off the back?

Brian: Off a person’s back.

DM: Yeah, then an oil gland plugs and then instead of putting the oil out on the skin, it all collects underneath and initially it’s liquid, but then it turns into more of a Crisco, cottage cheese-like thing. But… And so…

Brian: So what, do you just glance, then have to get that out of there and…

DM: Yeah, then take out the whole shell of it, but sometimes those…

CA: I’m not sure this was a good first episode…

[laughter]

DM: So for me smells are a bigger deal than the visual, and so that’s one thing that will… And some people just have that trait where, it’s called a vasovagal response where the…

Brian: I’m not just a wimp.

DM: Well, [laughter] I’d have to know more information to make a…

Brian: I wanna write that down, a vasovagal response.

DM: And what happens is that they just… Their heart rate slows down and they don’t have as much blood pressure going to the brain and they can faint from that. The one thing that’s interesting is that…

DM: But one of the things that’s interesting is that, let’s say your kid had something happen where they’re bleeding, you would be able to take care of them. The minute the ambulance people, or the minute you got on… Then you would freak out and you’d probably feel faint and then maybe…

CA: See, that happened to me. I tried to give blood once, almost passed out. And then fast forward say 10 years, they had a blood drive in the building. I was like, “I’m doing it, mind over matter.”

Brian: Really?

CA: I go in. I get tapped in. I didn’t look at it. I’m all done. And they’re like, “Alright, you did a good job. Go down and have a seat down there. Have a coke.” I reach over for a coke and I went right down. And I was like…

Brian: Did you take a header? Did you get hurt?

CA: Oh yeah, well no, no.

Brian: ‘Cause they should’ve been watching, right?

CA: I came to, well they were… They came over and got me and they sat me up. I was like, “What happened?” I was like, “I did it,” and that’s interesting to know that it was done and then it happens. So needless to say the Red Cross called me quite often after that because I did… The blood was usable. I gotta tell you, I passed out on the last one, they’re like, “Okay, we’ll take you off the list.”

Brian: So they didn’t have that written down, like, “He’s a fainter,” or anything?

CA: Well no, they didn’t write it down at the time, but it was funny because that’s exactly what happened and…

DM: Well, and I had a friend in medical school who hated blood, which doesn’t make sense, but he ended up going into psychiatry, which worked out perfectly for him. But because a lot of…

DM: And he, because a lot of people don’t wanna have medical students practice on them, we would draw blood on each other. And when…

Brian: Is this like he’s a roommate? I missed the part of this. I know I was sitting here, but when were you drawing blood with each other?

DM: During medical school, because we’re learning but no one wants to have a medical student learn on them, so we do it to ourselves. And he went to put in the needle on someone and he missed it in a wide and fainted. And…

CA: He did?

DM: He did. Yeah.

[laughter]

Brian: So psychiatry was definitely in his future.

DM: Along the same lines, now when you check pressure in the eye they do that blow test.

Brian: Yeah, puff.

DM: It startles you.

Brian: Right.

DM: It used to be you put something on the eye and then put little weights on it to see how much pressure there was. So when the medical students did that to each other, the next day when we had lectures, there’s three students that had an eye patch on, just ’cause they scratched the cornea when they… [chuckle] Yeah so it’s…

Brian: So I would assume it would be like a little suction cup. It was something else?

DM: Yeah, it was just something that was put on and it was kind of like a rubber-coated something that just would sit on the cornea.

Brian: So how long have you been practicing?

DM: About 18 years.

Brian: Okay. So in that time what are some of the biggest things that have changed? I’m assuming technology has changed some of it. Is it less than I would think?

DM: When I started I would dictate notes, someone else would type them up and then they’d put it into the chart, just put in there. And then, gosh, about 12 years ago we went on to an electronic medical record.

Brian: So it’s like automatic voice-to-text dictation or something? Or…

Brian: I don’t know if I have to beep that out, I don’t know how that works but…

DM: Yeah. I’ve had it for 10 plus years and that has gotten a lot better which is nice because when I was in 10th grade and took typing and when we’re on the left hand line that’s like A, S, D, or whatever it is…

CA: A, S, D, F.

DM: Yeah, after the first week of that I was getting a C and I said, “When am I gonna need this?” And so I dropped it and I rue the day I did that ’cause I can’t… I’m a hunt and pecker and…

Brian: Still?

DM: Yeah.

Brian: Yeah. So that helps administratively, but what about…

DM: Right.

Brian: You said they used to put something on your eye, now they just puff your eye. What are some of the things that they’re doing that… Or does that not necessarily happen at the general practice level?

DM: Correct. In the clinic level not as much. Some of the different advances in surgery and things have been wonderful, the robotic surgeries and things like that.

Brian: But you’re not doing that in your office for the most part?

DM: No. If I had a time life book, I don’t know, I could probably…

[laughter]

CA: Pull that off.

Brian: So, I wanna make sure I… I had a whole list here, we can go through all of them [questions].

DM: I know.

Brian: ‘Cause I want to know these things. Doctors get burned out, right? That’s a thing?

DM: That is a thing.

Brian: What do they get burn… So is that general practitioners or is that more to be specialists?

DM: I’d say more general practitioners.

Brian: And what does it? Just patients?

DM: I think the push to be more productive, to see more patients. Actually, one of the groups that I think gets burnt out a little bit more is kinda women primary care physicians, because men don’t talk a lot when they come in to the doctor. And so, they may have one or two things…

Brian: The male patients?

DM: The male patients.

Brian: Okay, sure. Okay.

DM: Female patients are a little more verbal sometimes and so a lot of times they’ll have more things to go over.

Brian: Wait, what are you saying, Steve, exactly?

DM: I’m saying that sometimes…

Brian: In your experience…

DM: In my experience… Yes. [chuckle] It’s…

Brian: Okay, so they talk a lot more and they tend to go to women visit?

DM: Physician. And so they go in for a physical and all of a sudden they have five other things to go over. And it’s just more work and it’s a little more taxing.

Brian: Right. So because they’re jabbering the whole time, all day long. [chuckle] Well, that’s basically what… So when you get home at the end of the day or whatever, you don’t wanna talk to people? Or is it not that big of a deal for you?

DM: Depends upon the day, some days are worse than others. For the most part, it’s not bad. The thing that is to try to stay on time, as I talk to the patient, I’ll put in the orders and the actual note may not be done.

Brian: The note of what happened.

DM: The clinic visit.

Brian: Right, right, right. Okay.

DM: And so, I may have, like tonight after this I get to go home and I’ll have 16 notes that I have to get done, which really isn’t a lot, when it gets up into the 80 and 90s, that’s when it’s gonna be hours.

Brian: So you gotta have a pretty good memory then, right? You can’t go, “Oh crap, what was that thing?” [chuckle] “I remember being grossed out, but I wasn’t… ”

DM: Yeah.

CA: It’s recorded all on the phone?

[chuckle]

DM: Well, a lotta times when the nurse or the medical assistant rooms the patient, they will put in what they’re in for and things like and then by my orders… So all I have to do is fill in the middle. So I know what I’ve ordered, I know what the diagnosis is and then I also have the information from the medical assistant, and so I can fill in the blanks.

Brian: Gotcha. Okay. So, what else did I have? Alright. So doctors make pretty good money, right? Do they make better money than they used to make, or less? I don’t wanna know what you make.

DM: No. I’d say, they…

Brian: Is it harder to make good money still?

DM: Not necessarily. It’s the way that, at least in primary care, the way that doctors are paid is when, if you come in, depending upon how difficult of a problem that we’re going over, we’ll code the visit as a level three or a level four and then there’s a certain amount of RVU, or Relative Value Unit, associated with that level of payment or level of service. So the RVUs are the same everywhere in the country. What they have is…

Brian: Who sets those? Do all the insurance companies get together and go, “This is what we’re gonna… ”

DM: Yeah, and the government does a little and that. So a level three visit, let’s say, is 0.8 RVUs, and so you add up all the RVUs for a day and then they multiply it by a conversion factor. And that conversion factor is a dollar amount. And so we’re basically widget makers. If you see more patients and you bill for more RVUs, that’s a higher number times this constant and that’s how much you make.

Brian: But, so the more complex, the bigger the RVU?

DM: Correct. So a level four is a more complex.

Brian: What would be a level four? What happens?

DM: Someone comes in with abdominal pain and we’re gonna order an ultrasound, put them on a medication, and do some lab testing. A average level three would be coming in with a sinus infection. We’re gonna prescribe a medication, but that’s about it.

Brian: What’s a physical?

DM: A physical is where you come in and I talk to you about… No.

[laughter]

DM: That’s probably it’s more than a level four, but it’s about two RVUs.

Brian: So how do you game the system? Do you just try to get patients that are hypochondriacs but have good…

CA: Good insurance? [chuckle]

Brian: Well, good insurance, yeah. But also good symptoms like severe chest pain, or…

DM: The way that it’s set up… So over the last three, four years the clinic that I’m working at now is, we’re aligned with Allina. So we work with them and so they actually do all the billing for us, and then we get a certain amount that we give to each doctor based on how many RVUs they’ve produced. Prior to being in association with Allina, we would just, whatever we billed and even the labs that we ordered and the tests that we ordered, we got the net. There was the gross amount and then after the deductions the net amount that we would get.

Brian: So you ever look at your list of all your patients and go, “It’s gonna be a good day”?

DM: No, not necessarily.

Brian: Are you don’t ever like, “You must be alright,” in your…

[overlapping conversation]

DM: ‘Cause if it’s all a bunch of cold and… But I mean…

Brian: ‘Cause you’re just trying to help people.

DM: Well, if there’s a whole bunch of colds and coughs then, okay that’s gonna be a lot of level threes. And I’m gonna probably stay on time very easily. The level four…

Brian: Okay, sure. Right. And then take more, yeah.

DM: So a level three is normally a 15-minute appointment, time-wise. So there’s three components to the visit: The history of present illness, the exam and then the assessment and plan. And so those three components are what cause the level of the visit to be at a certain level. And so if you have a whole bunch of level fours, okay, you just can’t see those as quickly as…

Brian: ‘Cause they’re more complex? Right.

DM: Yeah. So the day, you may only see 16 patients, but if they’re all level four, then…

Brian: So if the patients are coming in saying, “I only have these two ailments, I got a little bit of sniffle… ” and then they come in and go, “Oh, and my entire abdominen… ” and whatever, then do you…

DM: “We took the biopsy and it could’ve been beningning or maligningning and it also… ” But anyway. Your abdomen is…

Brian: But if you do mispronounce something, do you just have to keep going with it? You just, ’til the end of this particular patient…

DM: Oh, you have to own it! [laughter]

CA: Yeah, I was gonna say you gotta own it because you… They’re coming at you, who knows…

Brian: Right. Although… So do they ever… I just realized this, and I haven’t done it yet, but I could do this, I realize. I could look up what he’s saying I have, real time and go, “Ah, I’m… ” Do you have anybody doing that? Just checking your phone?

DM: That would…

Brian: It’s gonna happen, right? The kids of today are gonna grow up…

DM: No no no no. Oh, no, I know…

Brian: And go, “I’m not buying it, doc.”

DM: Well, every now and again a patient will say… ‘Cause now with the electronic medical record, the one that we have now, people can have a MyChart version and they can look at their chart. Exactly. And sometimes they’ll go, “Hey, that diagnosis on there, that’s not me. I don’t have schizophrenia.”

[laughter]

Brian: Right? I don’t, right? No, yes, I don’t.

[chuckle]

DM: But those are the things, but for the most part it’s…

Brian: I feel really bad ’cause I did… And here’s why I did that. I did that thing where you go, they call in and are like, “What do you wanna see the doctor about?” I’m like, “Well, I got A and B.” Because I don’t know who she is. I’m sure she’s a professional. But, right? She’s got friends and they’re probably not maybe as… I’m talking about the person who takes the patients.

DM: We talk about patients all the time. [chuckle]

Brian: Well, that’s what I’m saying! So I don’t wanna go in there…

CA: Anonymously.

Brian: C, D, and E until I get the guy in there. And then I tell them C, D, and E. Can I just say, “I’m a level four”? Should I do that? “I’m a level four… ”

CA: I need extra time. You don’t wanna sound like you know too much, it might decrease the quality of care.

DM: When you don’t wanna talk about it, 99.9% of the time, the nurse will run a, “Wants to talk about erectile dysfunction.”

[laughter]

Brian: That’s the default go-to. The default.

CA: Oh that’s funny! Yeah, yeah, there’s kinda… Yeah, yeah.

Brian: So, just to clarify, that wasn’t C, D, or E in my case.

CA: I have been in the same situation, but it’s more because…

Brian: For ED?

CA: No, no, no, no. Not yet. [chuckle] But I wanna make this a bulk visit, right? Because I gotta pay… Well, my insurance has changed over the years, where it was like the HMO versus the PPO, and now it’s like we’re on a HSA. So if I have to make multiple appointments, which I mistakenly did a while back, it was like, when you see the bill of what you’re really charged is… And so, I’m in that same situation, I’m like, “Give me all these things.” But then I know…

DM: Yeah. We see it all the time, where it used to be that the year started and we’re busy or steady. Now, we are the busiest at the end of the year… Because people…

Brian: Oh, ’cause everyone just wanna burn off their…

DM: Oh yeah, they’ve reached their deductible and now they want everything done before the end of the year.

Brian: Right, right. To get it all in.

DM: And so it can be busy. It used to be you’d choose between one, or two, or maybe three plans and that was it. Now you get to pick your copay, your coinsurance, your drug plan, your deductible. There’s about 45 permutations on what you could pick, and it’s almost like a gamble, and it’s like, “Well, what’s it gonna be like this year?”

Brian: Yeah, we could do a whole show on how crazy the system is, because it’s crazy the way they push you to see more patients. It’s crazy the way they just set this thing up and we’re like, “Oh, jackpot.” We gotta…

DM: Yeah. The nice thing about the clinic that I’m at, is because we aren’t… We’re in affiliation with Allina, rather than owned by Allina. So we still have a little tiny bit of autonomy and that’s nice, ’cause then we’re productive so they leave us alone. But they don’t come in all the time and say… But the problem, or one of the things that is coming up is all the equality issues, which are good but what ends up happening, is we spend so much time… For all their diabetic patients there’s five criteria, that if they hit all of them then we’re considered a good doctor. If they take an aspirin, they don’t smoke, blood pressure’s to a certain level, a long-term diabetic test called a Hemoglobin A1C is at a certain level, and their bad cholesterol is at a certain level. If we have all five of those then it’s a good thing. If they only have four out of the five, then we fail. So, we pass if they have all five. So I may have the patient, everything’s great and but if they smoke, I fail.

Brian: If he just doesn’t take his aspirin, or whatever?

DM: So the insurance companies grade the doctors on different things. And one of the things is how many times is a woman getting testing for STDs when they’re between 20 and 35? And my answer then is, “They’re paying the bill, they know if it’s been done, so why do we have to look into our charts and then send something to them to tell them that it’s been done?”

Brian: Yeah, that’s crazy. So back on what you make. And not what you make… I did my research, right, and I found out…

DM: There’s stuff on the internet about that?

Brian: Yeah, and I’ll put this out on the website. But this is a list of all the specialties, including family medicine.

DM: Yes. Correct.

Brian: And you are third from the bottom, you make third from the least.

DM: Correct.

Brian: You make… Yes. There’s probably a better way to phrase that but I didn’t say it.

DM: Yes. From the bottom.

Brian: The number one… Read that, what does that say?

DM: Orthopedics.

Brian: Orthopedics make the most…

DM: The bone doctors.

Brian: Is that what that is?

DM: Yeah. Yes.

Brian: More than cardiology? More than…

DM: The reason for that is, in medicine you get paid to do things rather than to listen to patients.

Brian: But, what about… So my older brother got colon cancer and so then, at the age of 30 I had to start getting colonoscopies. So, who are those guys?

DM: That would be your colorectal surgeons.

Brian: It’s not gastro… Whatever that one was.

DM: Gastroenterology, they do that, but there’re the internal medicine doctors who specialize in the GI tract, they don’t do surgery but they do colonoscopies and esophageal-gastro duodenoscopy, or EGDs.

Brian: You’re just making that up, right?

[chuckle]

Brian: So here’s the thing, he should be at the top. Whatever he gets paid should be the top [pay].

DM: Well, one of the things that… Psychiatry…

Brian: I don’t know… Have you had one yet? You’re not old enough, are you?

CA: No, I did. Same thing. Family issue. I had to have my first one when I was 40.

Brian: Oh really? Yeah? Really?

DM: But, yeah. Psychiatry, internal medicine, allergy, infectious disease, family medicine, endocrinology, pediatrics, they don’t do a lot of procedures and so you’re paid to do…

Brian: Oh, it’s all in doing the procedures.

CA: Interesting.

Brian: Critical care.

DM: And normally ophthalmology’s up there pretty high, but I don’t see them.

Brian: You don’t see it?

DM: Yeah, with all the cataract surgery.

Brian: Well, it’s on the internet.

DM: Oh, they’re right there. Yeah.

Brian: Okay. So here’s the other graph I got, and I’ll put this one up there too, but this is the difference between genders. So, males make a lot more than females in the medical industry. Is that correct? According to this, it is.

DM: According to that. And part of the reason for that is… It currently isn’t the case at the clinic that I am working at now, but at the clinic I was at prior to that, all the female physicians worked part-time.

Brian: So, don’t you think they’ve controlled for how much work?

DM: No. We’re widget makers; in other words, however many patients we see that’s what we get paid.

Brian: Wait a minute, are you a W-2 employee to a company or are you self-employed?

DM: Self-employed, but we get W-2s.

Brian: Alright so, however many hours they work is how much money they make. So that’s…

DM: Correct.

Brian: I’ll have to check, but that doesn’t really get…

DM: So it’s somewhat misleading.

Brian: Yeah, although it does say, based on this, four years ago you were making a lot more money… Not you, but the doctors make a significant more amount of money than they did four years ago. So you’re pretty pro-Obama then, on that? Is that due to him? Is that due to Obama Care?

DM: No, the main thing with ObamaCare is it’s more to do with insurance than with doctors.

Brian: Okay, does that help or hurt doctors?

DM: It depends. If more people are insured, then they’re probably gonna go to the doctor, so we might be a little busier. I guess out in… Or wherever Romney was from, he implemented something that was similar to that and the minute it was implemented the emergency rooms were crazy busy, because now people had insurance but they didn’t have a regular doctor. And so initially the costs goes up. And then not being able to deny someone because of a pre-existing condition. And so it’s more insurance-based. And if you just have a certain amount of money that you can pay out for medical expenditures, so if there’s more of them, then the amount that they pay out may go down. And what they’ve tried to do is to keep family practice interested and so that people would go into family practice and some of the lower ones, is they try to keep their reimbursements the same and some of the other ones that may be going down a little bit.

Brian: So are men better doctors than women, Steve?

DM: Ah, no.

Brian: No? So, honestly I’m just trolling you, if that’s the right term. But they must be better at certain things. And what I mean by that is a certain style of patient would respond better to women in a certain situation…

DM: It really depends. You see more abrupt physicians who are both men and women. And you see more empathetic and ones that… They don’t care and will take an hour and a half with a patient if that’s what is needed. So it really…

Brian: Right. What’s interesting is when it’s a mismatch, ’cause… So I was looking for a doctor and I went to Steve. Well, first of all, I asked my wife, “Should I have Steve be my doctor? A, I trust him he’s a smart guy, but B, it’d be a little weird when we’re at a dinner party and just going there… ” [chuckle] So, he’s not. So I sent him an email to tell him, “Hey, I’m looking for a doctor. Ideally, he’s old enough that he knows his stuff, but young enough that he’s not gonna retire before I do… ” And he goes, “Oh, I got a guy. You should go to Dr. X.” I’m not gonna say his name without permission, or whatever. And I go, “I just wanna let you know… If ideally, he’d have smaller hands,” [chuckle] and he writes back, “Well, you’re gonna enjoy Dr. Sausage Fingers, then.” So, I go to Dr. Sausage Fingers, from now on that is his name.

DM: He’s German.

[laughter]

Brian: Exactly. But he’s a talker. I’m ready to get out of there. I’m just ready to say, “Next, lets must move on.” He’s fantastic, he’s a fantastic doctor. I’m not trying to diminish him in any way; certainly knows his stuff, certainly has helped me a lot, but how as a patient do I move a doctor along? I suppose you don’t really have that, or you haven’t experienced that?

DM: Well, just start getting dressed.

[laughter]

CA: Interesting.

DM: No, sometimes I’ve had patients say, “I have to go to a meeting,” or, “I have to… ” You can kinda make something up…

Brian: Right. Like, “I’ve got better… ” Okay, alright. Yeah. You had a question, you wrote something down. Have you had a chance to ask your question, ’cause I’ve got a couple more [questions].

CA: Okay. You were talking about earlier about doctors talking about each other. So I can’t remember, it was on some podcast, but they were talking about there was an Instagram-type app for doctors (Figure One App – Figure1.com). So doctors will take this cyst that you’re talking about.

DM: “Have you ever seen something like this?”

CA: Well, and they’ll post it on there and the patient has to sign a consent, but they were just talking about how you could see to the lay person, something like you and I were saying like, “Horrific.” You could see a trauma or whatever. But have you heard of…

DM: I have not. I’ve not heard of that.

CA: I can’t remember what the name of it was. But it was really interesting listening to them talking to… They were like, “Yeah, it’s… ” They have…

Brian: So what’s the purpose? So doctors can learn from each other or just kind of like vent from…

CA: Well I think learn from each other, but they…

[overlapping conversation]

DM: Kinda consult a side consult.

Brian: Oh that?

CA: But I think a part of it too, what they were pointing out in this is some of the comments to you or somebody coming from the outside might have been like, “Ooh, that’s… Well, how could they say that?” But like, “This is what they see.” And one of the points they were trying to make it was like it’s almost therapeutic. There’s a point of like: You see this stuff day after day after day, and how do you deal? So it was really interesting. Initially…

Brian: Behind the scenes, you wanna talk to somebody about it.

CA: Yeah, ’cause you think about it like, “Oh… ” At first, there is a little bit of a shock there like, “I can’t believe they’re posting that.” And it’s like, “Well, no, they have consent.” And then they’re kinda joke… It had a comment section on it, so it was…

Brian: I’m gonna notsee that.

CA: No, no, no. I do not wanna see it either, but I thought it was interesting because I can’t imagine the 20 patients a day. However many days a year that you’re working, [chuckle] there’s a lotta stuff to see. [chuckle]

Brian: So have you ever seen anything where you’re just go, “Okay, this is crazy. And they’re just lying to me about what they did”? There was this thing on the internet where someone had a light bulb up their back side. And they quoted…

DM: Under their shirt?

[laughter]

Brian: Yes. Under their shirt, yes. And their claim was they fell on it.

DM: That’s kinda like a…

[laughter]

DM: Like the Seinfeld episode, where he fell on the… Fusilli Jerry? I don’t know if you’ve ever saw… If you know Seinfeld…

Brian: Yes. Well, I’ll have to look that up too.

DM: Yeah, you know but that just…

Brian: So do you feel like they lie to you a lot? Not necessarily about specifically something like that, but I don’t think…

DM: Not really, although we’re told that when we take the history during a physical, and however much someone says that they drink, multiply it by two.

Brian: Really?

[chuckle]

Brian: Which, I think people who do research, they have to take into account anything that’s self-reported is probably wrong, and everything that’s reported to you, until you start seeing it firsthand is probably wrong.

DM: Yeah, some of it… And it’s hard too, ’cause at some point, you have to trust that the patient is being straight with you and so it’s hard. Every now and again, there will be a patient that comes in with pain. And you give ’em medication and lo and behold, they’re getting pain medications from other doctors, and you go, “Gosh, I didn’t… ”

Brian: You can do that?

DM: Oh, yeah.

[chuckle]

DM: Well, I used to be able to.

CA: Yeah. You used to be able to. Now, you can’t even buy a month’s worth of allergy medication that has the…

DM: Do you go in into your yellow suit with the clothes?

CA: Yeah.

Brian: ‘Cause that really is kind of a…

CA: Walter White look?

Walter White (Wikipedia)

Brian: Yeah. [chuckle]

DM: But the thing about that… It used to be that… Well now, Minnesota has, along with some other states, any time you fill a prescription for a controlled substance, whether you pay cash or not, it’s documented. So, if… ‘Cause our clinic up until we were with Allina, we were independent, so we’d get a lot of the drugs seekers because we couldn’t look in and see all these other clinics if they had been in for that particular reason. And you pull up on this now, and it’ll tell you all the things that they’ve gotten and from where. And so I’ve had once or twice where I’ve walked in with this slip of paper and said, “Hello, well I know you’re here today, and you would like that. But I see that you got 30 Percocet yesterday with Dr… ”

Brian: So are they re-selling it, or are they addicted to it, or are they making something else out of it?

DM: Yes. Yes. [chuckle]

Brian: Okay, alright. But you don’t have to report that? You don’t have to report the attempt to try to get more than you’re supposed to?

DM: No, no. No. Correct. Correct. But you can flag their chart to say “drug seeker”.

Brian: What do you have to report? Is there stuff you’re reporting on? Dr. Sausage Fingers, is he reporting something on me that I shouldn’t…

DM: [chuckle] At the end of the show, we’ll get into that.

[chuckle]

DM: What you have to report is if anyone is threatening someone else or if they say that they’re gonna kill themselves and things like that. So most of it’s… If harm is gonna come to someone…

Brian: Someone, either themselves or someone else.

DM: Yeah. And a lot of times… So with the HIPAA restrictions now, if your wife calls Dr. Sausage Fingers, and then says, “I wanna know about… ” Unless you said it’s okay, we can’t say anything.

Brian: Oh, to the spouse or anybody else.

DM: Correct. And that drives some people crazy. We’ve had moms calling in on their 19-year-old kid saying, “What happened with him?” And I say, “Unless they sign off on it, I can’t say anything.”

Brian: So it’s 18 or older. Is that what it is, or 19?

DM: I believe it is, 18.

Brian: Oh, interesting. Alright, so what was the thing that… Because I faint a lot, what’s that called?

DM: Vasovagal response.

CA: Vasovagal.

DM: I’m gonna need you to you write that down. Here’s another response I realized I had recently, and I think it’s pretty universal. I saw a guy, and he was missing his arm from this mid-biceps down…

CA: My cousin?

[chuckle]

Brian: I don’t know. Was…

CA: Yeah, he actually does, from here down.

Brian: Is he gonna watch this show?

CA: No.

Brian: Okay. So, it grossed me out and it’s… And I don’t know why, it’s so stupid. It’s just… Is there an ailment for that, other than stupidity, I guess?

DM: Probably.

Brian: Is that a thing? ‘Cause I asked a couple of people. Does it make you a little bit like… Not your cousin, but…

CA: No. I try… Because, you see people, and you just… I don’t know. I try not to… I look at it, it’s like…

DM: Well, it just kind of goes toward your own mortality. We’re all gonna die.

CA: Yeah.

DM: And people don’t like to talk about that.

Brian: Right. Okay.

DM: And, you hope that it’s a long time away.

Brian: So it plays in on that, yeah. Right. Like it’s…

DM: So it’s kinda like, “Gosh, he doesn’t have his arm, and that would be awful if that happened to me.”

Brian: Okay. So, it’s normal, is what you’re saying?

DM: Yeah. Yeah.

Brian: Okay, so I was looking… I did see something. Interesting fact here. It says, “The number three… ” Okay, “According to a recent study, medical errors are the number three cause of death.” So, do you think that, that’s family practitioners?

DM: No.

Brian: Or is that the specialists?

DM: Probably more that.

CA: Is that a tool left in?

Brian: I don’t know. It didn’t say. Do you think you’ve made any mistakes, that have… [chuckle] It’s really unlikely that you could, right?

DM: Oh yeah. There’s always… There’re mistakes that happen, it’s just with the things that I’m doing, normally it’s not anything that’s gonna cause any major harm to anybody.

Brian: Life-threating. Right.

DM: Whereas, if you’re in and working around someone’s heart…

Brian: Sure, higher propensity.

DM: Yeah.

Brian: Higher probability. But having said that, all of your patients die eventually, right?

DM: Yeah.

Brian: Yeah. Does that affect you at all? You will not be successful completely with any of your patients.

DM: No, because it’s a known thing that’s going to happen.

Brian: Okay.

DM: So, at least if I can get them to a certain age and they have a good quality of life.

Brian: Okay. That’s how you measure it.

DM: Yeah, I have patients all the time tell me that I should read this or that, and I normally never get a time to read.

Brian: Okay.

DM: Except for the week that I go on spring break with my kids. And so, last April I read a book that about, six or seven patients told me about called, Being Mortal. And, it’s actually a really good book.

Brian: Okay. I assume, it’s about dying?

DM: Yes, but how people die and the things that are important to them. If you have, let’s say you have cancer, and you’ve gone through one round of chemo, didn’t work, you’re going to the second, and third, and fourth. Well, should you have really gone to the third and fourth? It may get you an extra two weeks, but if you’re nauseous for the month that you’re being treated for it, is it really worth it?

Brian: Right. Right, quality of end of life, is very key.

CA: Yeah. Well, and that’s something that I think that you don’t… Having my mother-in-law passed away last summer, and that was one of those things that, you don’t wanna think about it but it gets to a point where… You could…

DM: You need someone to talk straight to you.

CA: Yeah, and…

Brian: So, I can tell you right now, I’m gonna do an episode on death, because my father passed away last year, and my mother is in a nursing home, with Alzheimer’s. And you just, you see people that their body is still alive, but it’s just not worth it. So, we’re gonna do a conversation on that. But, I wanna get to something a little more light-hearted.

DM: Okay.

Brian: Did you have any other questions? ‘Cause I got a couple of lightning round of questions.

CA: I got one question.

Brian: Bring it on. Bring it on.

CA: Social situations like card game, dinner party, whatever. What’s the over-under in minutes before somebody at the party asks for a diagnosis?

[chuckle]

Brian: I have not ever done, right?

DM: Right.

Brian: None of the, either…

DM: What’s interesting about that, is a lot of times it’s not necessarily my friends.

CA: Right.

DM: It’s either people who don’t know me or their spouses.

Brian: Oh, sure.

CA: So it’s so funny because my wife… Now it’s some of my parents friends know that she’s a pharmacist…

Brian: Oh, God.

CA: And they have a son that needs… He was switching to a generic… And my mom…

Brian: Calls her out?

CA: Calls with… I was just like, “What?”

[laughter]

CA: ‘Cause I’d always heard, it’s like…

Brian: So, what do you do? Do you just go, ” I’m off hours,” or, “You should talk to a specialist,” or…

DM: I remember, when I was in medical school, one of my friends, his fiancé who is now his wife came up to me and said, “I’ve seen three doctors and they haven’t been able to figure this out. Is there any way you could help me with this?”

Brian: Right.

DM: And I looked at her and said, “If three doctors couldn’t, and I’m in medical school, I may not be able to do that.”

DM: And at the same time, there was one time where I felt like I needed to intervene because one of my other friends’ wife have a goiter, a huge swelling of her thyroid gland. And I just said to him… I pulled him aside and said, “Has she had anyone see her for this?” And he said, “Well, she really is anxious around doctors, and currently her doctor is on maternity leave for another couple of months.” And I go, “You may wanna get in before… ” So, yeah.

[chuckle]

Brian: She gets back. Alright, so here’s… I was asking… I was telling my kids I was gonna be interviewing a doctor. And I said, “What questions do you have?” And so, my youngest daughter said, “Ask him, ‘Are all doctors good looking?'” And I said, “You know him, it’s Steve.”

[laughter]

DM: So, no. [chuckle]

Brian: No. Not all. [chuckle] So, the question was: Which of these actors, do you feel you’re closest to? Ready?

DM: No, but they had chicken lips or something called Dr. Burns. I would probably say Doogie Howser.

Brian: Doogie Howser?

[laughter]

Brian: Alright.

DM: Or, a close second would be Dr. Quinn, Medicine Woman.

Brian: So this is first episode, we’re gonna test this out. We’re gonna play a game. You have three different choices. You can play “lightning round”, “would you rather”, or “get to know you”. Right?

DM: Lightning round.

Brian: Good, ’cause that’s the only one I’m prepared for.

[laughter]

CA: Perfect.

Brian: You did that perfectly. And I didn’t even prompt it. Alright. So, we’re gonna ask you questions. You can take it slow or fast, as long… Man, we’re running out of time, so this is super lightning round.

DM: Okay.

Brian: Alright. Bad question. Next one. When was the last time that you sang a song that you knew all the words to, other than Happy Birthday?

Brian: There’s gotta be… But there’s no word for it that I know of, right?

DM: Yeah.

Brian: Okay. Who was your first kiss?

CA: Heather Kelly.

Brian: Wow, and?

DM: Oh, gosh. Stacy Firth.

Brian: Alright. That’s lightning round. So here’s what we’re gonna do, guys. I gotta wrap up here. I wanna say first off, thank you Steve, great conversation. Chris, great conversation. Really appreciate you both coming out. This was the first episode. I don’t think it was… What was it? What were we trying to avoid? A dumpster fire.

DM: A dumpster fire.

CA: A dumpster fire.

[laughter]

Brian: I don’t think we were quite a dumpster fire. I don’t know.

CA: No.

Brian: We’ll have to find out. For that one or two people that are listening, hopefully they enjoyed it. There was a lot going on in this episode. You’re gonna tell me what that ailment is I have, we’re gonna look up all these references and we’re gonna get to those…

DM: One of the ailments that you have.

[chuckle]

Brian: Yeah. Hey, wait a minute. Sausage Fingers is not talking to you, is he?

Brian: XO Friends. You can see us on our website at extraordinaryfriends.com. You can follow us on… Let’s see. I’ve got all sorts of things. We’re gonna do it all. We’re gonna do it on Facebook, of course, we’ll be on Facebook. And then, we’re also gonna put this on YouTube as a video, and then lastly we’re gonna also put it on iTunes as a podcast. So we don’t know how often these are gonna come out but this was great. I had a great time and so we’re gonna do this again.

CA: Alright.

Brian: And I don’t know. Did you have any other questions? We got a minute or two left.

CA: What’d you name your cadaver in medical school?

Brian: That’s a thing?

DM: We didn’t name it, but I want to say that when the group next, something happened and their cadaver didn’t have a brain, so when they found that out they sang the Wizard of Oz song but…

Brian: There’s a joke there and we’re not going there [chuckle] but… So, what gender was your cadaver?

DM: Male.

Brian: So, is it always evenly split like male, female? Is there any… You can’t pick it, right?

DM: Right, right. That I don’t know. That I don’t know.

Brian: Alright. And then last up, what do you eat for lunch every single day, to get you working?

DM:Davanni’s. I will go between a thin crust, traditional, or deep dish.

CA: You’re kind of a pizza guy.

DM: Yeah.

Brian: Every single day.

[chuckle]

CA: Really, every day?

Brian: Every day.

DM: Yeah. And cherry vanilla coke.

CA: Oh, wait. You’re laughing because you eat a bear claw. It gets stuck right here.

Brian: I know. But I’m not a doctor. I’m not a doctor. Yes. Yeah. That’s okay. That’s all good. Yeah, I just think that’s hilarious. Alright. Well, thank you both.

CA: Thank you for having me.

Brian: I wanna thank everybody who’s listening in and like I say, everything that we talked about will be found on the website, so you can find it there. Alright.

CA: Alright.

Brian: Thanks.

[music]

Podcast Outtro

Brian: Alright, there you have it. The very first episode of The Extraordinary Friends Show podcast. I wanna thank my guests, Dr. Stephen Meade and Chris Alme for making it a great show. The warning voice over at the beginning was by Veronica Razzler and the music was by Ben Sound at bensound.com. If you get a chance, let me know what part of the show you liked best. You can get me on XO Friends on Twitter, or at our website at extraordinaryfriends.com. Now, here’s some outtakes from the show.

Outtakes

Brian: I have no idea [chuckle] if we’re actually off the air or not. Paul…

CA: I’m glad we didn’t get to that one.

Brian: I wanna thank Paul for being…

[background conversation]

Brian: I also wanna send out a special thanks to my friend, Paul Kibbe, who on very short notice, showed up to be the cameraman, did an awesome job and learned a lot, now he’s certified to be a cameraman, so now I’m sure it’ll be on LinkedIn tomorrow. But, no, a huge help, appreciate it.

CA: Now the one thing that, ’cause there was a time…

[background conversation]

Brian: Alright, so here’s what I really want. Are we at an all cam? This is a safe shot, right? Alright. Alright. Here’s one other thing… There’s, I think, three things we gotta do before you guys take off. One is, we have to laugh and we had a lot of good laughs but put aside, if you would, put aside to… We’re gonna laugh as if it’s the funniest thing we’ve ever heard.

[laughter]

DM: Well, so Mickey and Minnie go to the psychiatrist’s office. [laughter] And the psychiatrist says to Mickey, “Mickey, Minnie’s not crazy.” And Mickey says to the psychiatrist, “Doc, I didn’t say she was crazy, I said she was f**king Goofy.”